Dentistry Today — September 2011

Inside this issue

Excerpts from the issue. Open the digital edition to read any page in full.

1. Page 4

   Endo Direct SMARTER, BETTER, & QUICKER ENDODONTICS the original sonicMM1500 a must have complement for all endo systems An advanced sonic vibratory endodontic system that follows all traditional principles, safely, efficiently and without operator stress. Rotary NiTi Instrumentation All NiTi systems are excellent in creating a crown down effect, BUT they do not irrigate or cleanse the lateral canals. These canals are breeding grounds for bacteria, which in effect will increase post-op pain and inevitable retreatment. Sonic MM1500 Original The Sonic MM1500, with it's cavitation effect, will effectively cleanse the lateral canals and greatly reduce post-op pain and patient recalls…

2. Page 12

   Embracing Technological Advances I recently visited the Museum of Science and Industry in Chicago with my family. On display there is a dental operatory filled with old equipment, machinery, and instruments (donated by a local dentist) to demonstrate how a treatment room used to look many years ago. One can quickly see just how far we have come in a relatively short span of time. When I lecture in North America, I often inquire how many utilize in-office CAD/CAM, laser, or digital impressioning technology. It is surprising to see how few raise their hands to affirm the implementation of one…

3. Page 13

   G·U·M® PerioShield™ Oral Health Rinse The Plaque Stops Here. The Next Generation Oral Rinse • A new and innovative aid for the prevention and treatment of gingivitis, which could lead to periodontitis¹ • Only rinse containing delmopinol 0.2%, a proprietary ingredient that creates an invisible "molecular shield" around teeth and gums²·³ • Clinically proven to reduce plaque buildup and bleeding gums by up to 36%¹ • Safe and effective for long-term use with low incidence of discoloration²·⁴ • Not bactericidal SPECIAL OFFER CALL 800-528-8537 or on card G·U·M® PerioShield™ breaks down plaque, making it easier to remove, and coats teeth…

4. Page 14

   Dental Sleep Medicine—Is It Right for You? There might be 90 million Americans with some sort of sleep-disordered breathing, but perhaps 10% of them have been diagnosed. Among that, so million are sleepy truck drivers, people soon to have heart attacks, folks who struggle with blood sugar problems, and some worried dental patients. Dentists fancy themselves a critical part of healthcare. Indeed they are, but I wonder how many feel that because they do oral cancer screening exams and take blood pressures on their patients they are maximizing their "nondental" efforts to help their patients achieve optimal health? ARE YOU…

5. Page 16

   continued from page 14 your investment in the education process means you must have a plan to make bigger profits in providing the new service, or you are willing to accept less income because of the expense of the training needed for you and your team. Either choice is workable, but your decision should influence the type of education you choose. If you are unsure whether treating sleep-disordered breathing patients is right for your practice, choose a course with minimal investment required and learn what you need to know before you spend a lot of money on one of the…

6. Page 18

   Dentistry Today.com Providing you with news and information from the industry leader in clinical content. Visit Our Site Today! Technique of the Week No-Prep Veneers David Hornbrook, DDS, of San Diego, Calif, performs an A-to-Z clinical case with no-prep veneers. In this case study, Dr. Hornbrook utilizes several different procedures in his quest to perform a minimally invasive, step-by-step no prep veneer case. This high-definition video is provided by HDIO and can be seen as a full continuing education course on hdio.com. For more information, visit the Web sites or hornbrook.com. The CROWNING Online Articles Practice Management Tips Dentistry Today…

7. Page 20

   From the June 2011 Issue MATRIX BANDS Garrison Dental Solutions Pinch Metal Matrices are retainerless, Tofflemire-style matrices that simplify all posterior restorations. The precontoured 0.0015-inch metal matrix is easily positioned around the tooth to be restored, and the tensioning loop is pinched to tighten the band to the tooth. The restoration can then be performed without interference from traditional matrix retainers. For more information, call (888) 437-0032 or visit garrisondental.com. FREEinfo, PORTABLE DEFIBRILLATOR Darby Dental The ZOLL AED (automated external defibrillator) Plus is a portable defibrillator that guides the user in the practice of cardiopulmonary resuscitation. It features Real CPR…

8. Page 22

   NEW PRODUCTS SELF-TAPPING IMPLANT TECHNOLOGY Intra-Lock BLOSSOM, a new technology in self-tapping, screw-type dental implant architecture, eliminates the need for conventional flutes and vents that traditionally define self-tapping implants. Implants augmented with this technology feature a fully integrated tapping configuration that is distributed along the implant. BLOSSOM technology is currently available on selected Intra-Lock implants. For more information, call (877) 330-0338 or visit intra-lock.com. FREEinfo, REINFORCING TAPE Dentapreg.com Ideal for splint setups, postorthodontic retainers, frameworks for composite bridges, and stress-free posts, Dentapreg represents a new generation of preinforced high-bridging resinous tapes. When using Dentapreg, it's not necessary to impregnate the…

9. Page 24

   CLINICAL REVIEWS THE DENTAL ADVISOR www.dentaladvisor.com To assist practitioners in their selection of essential dental products, Dentistry Today presents items reviewed by THE DENTAL ADVISOR's staff of editors and consultants. Established in 1984, THE DENTAL ADVISOR, based in Ann Arbor, Mich, has provided dental professionals worldwide with objective, accurate information using in vivo and in vitro results on the performance of materials and equipment based on clinical and laboratory research. For more information, visit dentaladvisor.com or call (800) 347-1330. BEAUTIFIL Flow Plus +++++1/2 NeoDiamond +++++ Shofu Dental | (800) 827-4638 | shofu.com Microcopy | (800) 235-1863 | neodiamond.com Consultants' Comments…

10. Page 26

    Spotlight New Technology in Self-Tapping Implants Eliminates Need for Conventional Flutes and Vents BOCA RATON, Fla- Intra-Lock's BLOSSOM, a new, patent-pending technology in self-tapping, screw-type dental implant architecture, eliminates the need for conventional flutes and vents that traditionally define self-tapping implants. Implants augmented with this self-tapping technology feature a fully integrated tapping configuration that is distributed along the implant. The implants are angled and augmented by evenly spaced, crescent-shaped, helical-cutting segments. This design is intended to mitigate the high compressive forces that build up when conventional tapping segments become clogged with bone debris, which can unnecessarily increase insertion torque. BLOSSOM…

11. Page 28

    Package Offers Equipment Designed to Meet All Hygiene Needs MALVERN, Pa.— Designed to meet all hygiene needs in one package, Dentsply Group's new Simplicity Hygiene Package includes the Simplicity Light, and Delivery Unit with the new Dentsply/EZ integrated ultrasonic scaler, which utilizes proven magnetostrictive technology from Parkell, a company that has manufactured ultrasonic scalers and scaler inserts for more than 30 years. The Simplicity Chair's hydraulic system offers superior stability and smooth, quiet operation, and the chair features a thin, tapered back that is ergonomically designed and offers the hygenist the best access to the oral cavity while maintaining proper…

12. Page 30

    New Preshaped Collagen Membrane Redefines Ridge Augmentation CARLSBAD, Calif.–Stemming from an exclusive distribution agreement with Osteos Technologies, Zimmer Dental announces the availability of the Zimmer CurV Preshaped Collagen Membrane to provide focused bone augmentation and allow for vertical bone growth, this biocompatible membrane is intended to create an oral environment more suitable for implant placement. Composed of type-1 collagen derived from bovine Achilles tendon, the membrane offers a convenient solution for creating grafting material during the bone-remodeling process. Preshaped for custom molding to the posterior or anterior defect site, it can effectively house Puros Particulate allograft with minimal migration (when…

13. Page 32

    Software's Animations Clearly Communicate Principles of Occlusion to Patients TRUCKEE, Calif.- The 3-dimensional animations featured in BiteFX Occlusion Software help dental professionals communicate complex concepts of occlusion to their patients, and patients consulting BiteFX consistently produce a clear understanding of occlusion principles, yielding a significant increase in acceptance of more comprehensive restoration recommendations. Two ancillary offerings from BiteFX enhance the product's effectiveness: the QuickStart Education Program, and the Marketing Media Kit, which provides templates for dentists' Web sites to enable them to leverage their use of BiteFX to differentiate their practices from others. For more information, call BiteFX at (877)…

14. Page 34

    Spotlight New Sectional Matrix System Consistently Delivers Predictable, Accurate Contacts MILFORD, Del.—Palodent Plus, DENTSPLY Caulk's newest sectional matrix system, offers wide applications for sectional matrix system use and consistently delivers predictable, accurate contacts. The system includes molar and premolar rings, a different-sized matrices, and new wedges and WedgeGuards. The rings offer consistent separation force and are made of nickel titanium, which ensures they will last longer than traditional stainless steel rings. The tines on the rings help to provide excellent retention on the tooth, and the system seals the restoration to minimize the amount of finishing required. For more information,…

15. Page 36

    Dappen Dishes' Design Prevents Untimely Set of Bonding Agents [Image showing 4 different SuperDap dish designs labeled SuperDap 1, 2, 3, and 4] Australia -Available in 4 styles, Erskine Dental's SuperDaps are a new generation of dappen dishes that have been designed to stop bond agents from setting in the well of the dish (applies to light-cured bonds only). This is achieved because the well is designed to be narrow and deep, which restricts the light from penetrating it. One drop of bond can last for up to 24 hours. Time is critical when curing bond, and SuperDaps allow for…

16. Page 38

    Desensitizers Instantly Eliminate Pain in a Fast, One-Step Procedure NAPERVILLE, ILL.- Accepted by dental clinicians for more than 15 years, Hema-Benz Desensitizer and Hema-Glu Desensitizer G, both with fluoride, can be utilized in a fast, one-step procedure to instantly eliminate pain in all areas of sensitivity (cervical sensitivity, under amalgams, veneers, inlays, onlays, crowns, and under all composite restorations). The desensitizers are cost-effective, reduce reoccurring decay, and require no mixing or curing. For more information or to request a sample, call Health-dent1, LLC, at (800) 845-5172. FREEinfo, Device Repositions Tongue to Relieve Snoring CHATSWORTH, CALIF.- Offered by Success Essentials, the…

17. Page 40

    Patented Time-Release Vacuum Line Maintenance Tablets Now Formulated With AT-12 HOUSTON–To ensure consistency, Clearline Chemicals' Vac'ta'Clear and Shock'ta'Clear patented time-release vacuum line maintenance tablets are now formulated with AT-12, which produces an inner plating residual, eliminating any return of biofilm buildup. Most dental practitioners constantly battle with biofilm buildup and cross-contamination in their vacuum line systems. Commonly used daily liquid solutions and quick-dissolving tablets are pulled through vacuum lines at approximately 120 mph, leaving them mere seconds to do their job. Vac'ta'Clear w/ AT-12 is inserted once a week into each solids collector, slowly releasing its chemical daily throughout the…

18. Page 42

    Minimally Invasive Procedure for Denture Stabilization The MDI Mini Dental Implant System from 3M ESPE immediately stabilizes loose dentures using a 10-minute minimally invasive patented protocol, often completed without a flap and sometimes even using the patient's existing denture. Mini dental implants are designed for stability soft and dense bone, which is essential for immediate loading. Attachment designs are available for custom retention for each case with 3 retention options. These attachment designs forgive up to 40 degrees between implants with no need for an angle correction inventory. The MDI system consists of a 1.8, 2.1, 2.4 and 2.9 mm-wide…

19. Page 44

    NEWS/TRENDS Industry News John J. Jankowaik, 1939-2011 [Photo of John J. Jankowaik] John T. Jankowaik, retired president and CEO of Great Lakes Orthodontics, died this past August 3 at the age of 71. Mr. Jankowaik, who had been serving as the company's chairman of the board, was a dynamic leader and highly respected in the dental profession for his knowledge and integrity. Mr. Jankowaik joined Great Lakes in 1975, and his charismatic personality and work ethic earned him the presidency in 1989. During his 21-year leadership, Great Lakes steadily grew to become an internationally respected orthodontic company. He served on…

20. Page 45

    Piksters Interdental brushes What makes Piksters a better brush? • Resistance to bending and buckling • Extra durable PA612 Dupont Tynex bristles • Every brush has a cap "grab and go" • Slim, compact design, you hardly know it's in your pocket • Practical pack sizes • Free patient education materials • BIG choice in the smaller sizes • Plastic coated wires *There are many lower cost grades of nylon. Polyamides12 is the most expensive, resilient to hydrolysis and hydrolytic degradation. This is the reason why cheap toothbrushes go "shaggy" quickly. Like floss, only easier? NEW VARIETY PACK Contains 8…

21. Page 50

    Efficacy of Oral Appliance Therapy for Snoring and Sleep Apnea Quantified New research at the 20th Anniversary Meeting of the American Academy of Dental Sleep Medicine (AADSM) in Minneapolis quantified the efficacy of mandibular advancement splints (MAS) using a self-administered, at-home device to monitor snoring and sleep-related breathing disorders. Clinical assessment of MAS efficacy in the treatment of snoring and obstructive sleep apnea (OSA) is based predominantly on subjective reports by the patient and partner, and less commonly, on the apnea-hypopnea index (AHI), which is the average number of pauses in breathing that occur per hour of sleep. The current…

22. Page 52

    No Air Required Dr. Martin Chalfie is a co-recipient of the 2008 Nobel Prize in Chemistry for his groundbreaking work on green fluorescent protein (GFP) which has become essential for visualizing a variety of cellular processes with breathtaking, glow-in-the-dark clarity. However, the GFP and its variants required oxygen to work their magic, and that limited greatly their applicability to anaerobic, oxygen-phobic microorganisms. For scientists who study the oral biofilm, that can be a big problem. Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium spp., Peptostreptococcus, Eubacterium—all are anaerobic, and all are associated with chronic periodontitis. Following these bugs and their metabolism in real-time…

23. Page 54

    In First Impressions, George Freedman, DDS, gives readers a brief summary of products that have recently been introduced to dentistry, based on his clinical experience. Racegel Septodont Gingival bleeding during impression taking or crown cementation is a deal breaker. If the restorative process can not be accomplished in a moisture-controlled environment, it will fail. The same situation arises during the restoration of deep class lias and class Iv. In addition to the problem of hemorrhage, the continuous flow of crevicular fluid also tends to disrupt dental procedures. Gingival hemostasis has long utilized various sulphur compounds, despite the complication that even…

24. Page 56

    Sheer White! CAO GROUP There are any number of tooth whitening products available to the patient and the practitioner. Dentists generally prefer those that are distributed exclusively through professionals; this not only offers more clinical supervision for the patient, but it also is advantageous to the practice bottom line. At-home tooth whitening has evolved tremendously from the days of custom fabricated, laboratory trays, when the bleaching gel seeped into the mouth within minutes and was diluted and eliminated by the saliva. The Cao Group has recently introduced Sheer White! a trayless film whitening system that works effectively and predictably for…

25. Page 58

    DirectCrown Natural 1 DirectCrown Products Teeth break down even when times are tough. The dentist is often faced with the dilemma of the patient who needs a crown, and who would certainly have had one made under better financial circumstances, but simply cannot afford one right away. With the best intentions, a dentist simply cannot afford too many one-hour appointments, a dentist simply cannot afford too many one-hour appointments. DirectCrowns before the practice gins to suffer. DirectCrown Products has introduced the DirectCrown Natural 1, long-term provisional. It offers the clinical benefits of a single appointment, chairside nano-hybrid composite crown. The…

26. Page 60

    Glutaraldehyde/HEMA in Clinical Dentistry Every day the practicing clinician is faced with treating patients restoratively and preventatively to achieve long-term clinical results, while trying to keep emphasis of the treatment modalities, options, and anticipated outcomes, based on clinical experience and the current published literature. In the area of disinfection and desensitization, much has been published; many different approaches have been suggested with some of the literature contradictory. Work done by the TRAC Research team has shown that roots of preparations are highly colonized with a variety of organisms, and that water cooled cutting followed by teinization of collagen, mechanical stress,…

27. Page 62

    Glutaraldehyde/HEMA... continued from page 60 sities for caries as a susceptible host, suitable substrate, and cariogenic microflora. Mertz-Finnegan et al18 have shown that when bacteria are fully sealed under restorations caries is arrested. However, most dental materials permit the microleakage of bacteria, bacterial products, and oral fluids to reach dentin.19 with the oral fluids then providing substrate for any residual bacteria. Direct and indirect evidence that oral areas lacking in enamel such as the cementum dentin substrate show less stable substrate bonding,20 loss micromechanical retention,21 and thus favor microleakage.14 What should the clinician do when the restorative technique cannot guarantee…

28. Page 63

    ter group18 and its hydroxyl group with collagen because of its hydrophilic nature.37 Because these glutaraldehyde/HEMA products also contain water, they act as rewetting agents, and in the case of total-etch bonding producures, the "rewetting after the acid etch acts to expand the demineralized collagen and increase its surface energy, facilitating the diffusion of the hydrophilic monomer into the etched matrix."39 Does increasing the strength of the dentin collagen matrix, increasing the surface energy of collagen, and facilitating adhesion translate into higher dentin bonding strengths? EFFECTS ON DENTINAL TUBULAR STRUCTURE AND HYPERSENSITIVITY Dentin hypersensitivity due to dentin exposure, or after…

29. Page 65

    Test 141 Expiration date of this CE article is September 1, 2013. To submit Continuing Education answers, use the answer sheet on page 59. Circle the letter corresponding to the answer you believe is correct, detach the answer sheet from the magazine, and mail to Dentistry Today Department of Continuing Education. Or, use our easy online option at Web site dentalcetoday.com. This article is available for 2 hours of CE credit. The following 16 questions were derived from the article Glutaraldehyde/HEMA in Clinical Dentistry by Leendert (Len) Boksman, DDS, on pages 60 through 64. Learning Objectives After reading this article,…

30. Page 66

    Fixed Prosthodontics: Time to Change the Status Quo? INTRODUCTION Fixed prosthodontic procedures comprise a major part of the services provided by general dentists in the United States. It has been estimated by the National Association of Dental Laboratories that there were about 36 million units, most of which were single crowns, placed in the United States during 2010 (Bennett Napier, co-executive director, Dental Laboratories personal communication, January 2011). Assuming that there were about 120,000 practicing general dentists in the United States and roughly 3,500 prosthodontists, it appears that each general dentist placed more than 20 units of crowns or multunit…

31. Page 68

    Fixed Prosthodontics... continued from page 66 portion of the teeth is either destroyed by dental caries or has a previously placed defective restoration. Most of these types of restorations are placed by three practitioners using CEREC from Sirona Dental Systems (Patterson Dental) and E4D from D3D (Henry Schein) in-office milling devices to be discussed later in this article. However, we encourage more dentists who do not use CAD/CAM devices to provide onlays, because of their simplicity and conservative nature. In spite of our desire for more onlays and the resultant less tooth reduction, the easiest and indirect tooth restoration is…

32. Page 70

    Fixed Prosthodontics... continued from page 68 by digital impressions (to be discussed later), but conventional impressions are still by far the most popular procedure. Vinyl polysiloxane (VPS) has the majority of the US market, while polyether is still used by many practitioners. Two of the most popular and well-proven premium brands of VPS material are Aquasil Ultra Monophase (DENTSPLY Caulk) and Imprint 3 VPS (3M ESPE). Imprints PVS (3M ESPE) dominates the polyether market. Either type material (used properly) provides extremely accurate impressions. For those practitioners who have significant financial constraints, lower cost, proven brands are available from example companies…

33. Page 71

    Cementation Without any doubt, resin-modified glass ionomer (RMGI) cement such as Fuji LUTE (GC America) and RelyX Luting Plus (3M ESPE) have the majority of the market. These moderate-strength, fluoride-releasing, self-bonding, no-sensitivity cements have proven themselves over a long period of time. A growing category of cements, resin with an incorporated self-etching primer (such as RelyX Unicem 2 [3M ESPE] and Maxcem Elite [Kerr]) are proven cements in this new category amid a multitude of clones. These resin cement formulations have increased strength over RMGI, decreased sensitivity when compared to some other formulations of resin cement, and still retain the…

34. Page 72

    DENTAL MATERIALS more than one appointment, still requiring a provisional restoration. • Making the restoration. Digital impression devices allow fabrication of any type of crown you prefer from their authorized laboratories, just as with conventional impressions. Most intraoral impression systems now offer the capability of a milled model or a resin-cured stereolithographic model that the dental laboratory team can use in place of a conventional stone cast for fabricating the restorations. Initial studies have demonstrated these models to be equal to or superior to conventional stone casts. • Cementation is the same as for restorations made in a conventional manner.…

35. Page 74

    QUICK TECHNIQUE MULTILINK AUTOMIX Ivoclar Vivadent Multilink Automix is an innovative, multipurpose adhesive cement indicated for indirect restorations, inlays, onlays, crowns, bridges, and posts fabricated from such materials as metal and metal ceramics, oxide ceramics, fiber-reinforced composites, all ceramics, and precious alloys. Restoring parental, hydrothylically active acid monomers, Multilink Automix creates a reliable and long-lasting bond, regard less of the restorative material in the anterior and posterior segments. Designed for fast and easy application, the Multilink Automix system includes a one-step primer that self-etches, self-cures, and seals dentin, providing excellent marginal adaptation and high immediate bond strength. Delivery of Multilink…

36. Page 76

    Light Up Your Practice INTRODUCTION Louis Malekacher, DDS Lasers have been in dentistry now for a good number of years. We have been using lasers in our offices for close to 10 years. What is new in laser dentistry is that now the dental lasers have gotten much better and much less expensive. As a result, it is within the realm of all dentists to now begin to integrate laser technology into their dental practice. This is no different than any other technology that continues to improve and also becomes more efficient and less costly. From Electrosurgery to Laser Technology…

37. Page 78

    Light Up Your Practice continued from page 76 sible. Especially now, with the advent of the improvements in dental technology, the ability to perform many dental procedures without the use of local anesthesia is here now more than ever. I certainly would not want to practice any other way. CASE EXAMPLE 1 Restorative Work With Laser Technology A 45-year-old female patient came to our office with mild to moderate sensitivity present on tooth No. 28. Figure 1 shows the failing restoration with caries evident on the occlusal surface. At the initial patient interview, she reported, like many other patients, that…

38. Page 79

    Love it, love it, can't live without it. Sam Hamam, DDS After 20 years searching, I think the V3 is the best matrix system out there. Prof. Robert Ho, DDS These are the best rings yet. They just kind of snuggle in and push the matrix tight with great contact. Easier to apply and you will stay on for an MO on an upper premolar without sliding off the canine. Love them!! Twokidsnosleep on Dentaltown Love it, love it. I can't believe I practiced for the last 13 years without it. Damn, I am embarrassed that my Class II fillings…

39. Page 82

    Hygiene Update Effects of Silver Diamine Fluoride Silver diamine fluoride (SDF) has been shown to be a successful treatment for arresting caries. A study published in the International Journal of Pediatric Dentistry characterized the effects of SDF on dentine caries induced by Streptococcus mutans and Actinomyces naeslundii. The study involved 32 artificially demineralized human dentine blocks, of which 16 were inoculated with S mutans and 16 with A naeslundii. Either SDF or water was applied to 8 blocks in each group. Using scanning electron microscopy, colony forming units, and confocal microscopy, biofilm morphology, microbial kinetics, and viability were evaluated. The…

40. Page 84

    Intention of Prevention Understanding the Practical and Predictable Options INTRODUCTION As preventive health care providers, what is our intention for prevention beyond the scope of providing hygiene therapy and giving oral hygiene instructions? This article is not about the science of saving enamel or the dynamics of the dental caries process. It is intended to assist the everyday working hygienist in understanding the practical and predictable options for prevention. The intention is to help you become more knowledgeable about innovative and effective preventive products and the benefits that they provide. THE MYSTERY IS IN THE HISTORY Dental caries is an…

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